Healthcare Provider Details

I. General information

NPI: 1578354387
Provider Name (Legal Business Name): SPEECHY KEEN THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4303 S 103RD LN
TOLLESON AZ
85353-4184
US

IV. Provider business mailing address

4303 S 103RD LN
TOLLESON AZ
85353-4184
US

V. Phone/Fax

Practice location:
  • Phone: 602-565-6566
  • Fax:
Mailing address:
  • Phone: 602-565-6566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KIONA LYNN
Title or Position: OWNER/SPEECH THERAPIST
Credential:
Phone: 602-565-6566